Management of Patients with Asymptomatic Hyperuriсemia – to Treat or not to Treat?

The article discusses the causes of hyperuricemia, including the influence of factors such as obesity, metabolic syndrome, decreased renal function. Hyperuricemia is called an increase in serum uric acid more 360 μmol/l in women and more than 420 μmol/l in men. The most reasonable level of uric acid is considered to be no more than 6.8 mg/dl (400 μ mol/L), at which crystallization occurs under physiological conditions. The prevalence of comorbidities associated with hyperuricemia has increased over the past two decades. Hyperuricemia (and/or gout) can be a cause or consequence of a comorbid condition. While epidemiological studies suggest that hyperuricemia may be associated with cardiovascular, metabolic, and renal concomitant diseases, Mendelian randomization studies have not provided evidence that these relationships are causative. The discrepancies between the results of observational and clinical studies do not allow making recommendations about the potential benefits of urat-lowering therapy (ULT) in individual patients with asymptomatic hyperuricemia. The relationship between risk and benefit o f ULT is unclear. The risk of gout developing as a result of asymptomatic hyperuricemia, estimated at 50%, must be matched with the risk of skin and cardiovascular side effects of xanthine oxidase inhibitors. On the contrary, the need for optimal management of comorbidities is widely recognized. Among the drugs taken by patients to treat comorbidities, those therapeutic agents with hyperuricemic action should be canceled and replaced with drugs that have the opposite effect. Lifestyle changes, weight loss, if necessary, and sufficient physical activity are useful for improving overall health. Whether ULT has a beneficial effect on comorbidities will only be known if there are powerful intervention tests with appropriate primary endpoints.